Medicina

487 KiB

Open AccessArticle

Ethnic variation in self-rated health–mortality association: Results from a 17-year follow-up study in Estonia

by Rainer Reile and Mall Leinsalu

Medicina 2017, 53(2), 114-121; https://doi.org/10.1016/j.medici.2017.04.003 - 02 May 2017

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Background and aim: Previous research has highlighted the role of self-rated health (SRH) as an important predictor of mortality. With substantial ethnic differences in SRH and mortality reported in Estonia, this study aims to examine the ethnic variation in SRH–mortality association in this [...] Read more.

Background and aim: Previous research has highlighted the role of self-rated health (SRH) as an important predictor of mortality. With substantial ethnic differences in SRH and mortality reported in Estonia, this study aims to examine the ethnic variation in SRH–mortality association in this setting.Materials and methods: The baseline data come from the nationally representative 1996 Estonian Health Interview Survey. Individual records of 3983 respondents in the 25–79 age group were linked with mortality data with 17 years follow-up time. The association between SRH and all-cause mortality was analyzed using the Cox regression for two ethnic groups and separately for men and women.Results: Among ethnic Estonians, both men and women with bad or very bad SRH had about 60% higher mortality compared to those with good or very good SRH even after adjustment for age, socioeconomic and health-related variables. In contrast, SRH did not predict mortality among non-Estonian men and women. A strong and universal inverse association with mortality was found for personal income. Education (among men) and occupation (among women) predicted mortality only among non-Estonians, whereas ever smoking was associated with mortality in Estonian men and women. Overweight women had lower mortality risk compared to women in normal weight category.Conclusions: We found considerable ethnic variation in SRH–mortality association and in socioeconomic predictors of mortality. Further research, preferably focusing on causespecific mortality and reporting heterogeneity of SRH could potentially shed further light on ethnic differences in SRH–mortality association in Estonia and more generally on socioeconomic inequalities in mortality in Eastern Europe. Full article

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Open AccessArticle

Infantile hemangioma: Predicting proliferation by infrared thermography

by Arūnas Strumila, Vytis Kazlauskas, Gintas Pošiūnas, Gilvydas Verkauskas and Virgilijus Beiša

Medicina 2017, 53(2), 85-89; https://doi.org/10.1016/j.medici.2017.04.002 - 20 Apr 2017

Cited by 12 | Viewed by 1438

Abstract

Background and objective: Infantile hemangiomas (IHs) are benign lesions found in infants. Predicting the cosmetic outcome of these lesions is very difficult. Therefore, in this prospec- tive study, we assessed whether using an infrared thermometer (IRT) to measure the surface temperature of IHs [...] Read more.

Background and objective: Infantile hemangiomas (IHs) are benign lesions found in infants. Predicting the cosmetic outcome of these lesions is very difficult. Therefore, in this prospec- tive study, we assessed whether using an infrared thermometer (IRT) to measure the surface temperature of IHs would help to predict their proliferative potential.Materials and methods: Between January 2012 and March 2014, we prospectively investigated 103 children up to 6 months of age with a diagnosis of IH. None of them required immediate treatment. Two projection plain photographs of the IHs were obtained and the temperature of the IH surface was measured with the IRT at each visit. The IHs in these patients were divided into three groups: stable, slightly growing and growing IHs. We analyzed tempera- ture differences between the groups, relative operating characteristic (ROC) curves, and possible application of this method to clinical practice.Results: The median initial temperatures in the groups were 36.7 °C for the stable group, 37 °C for the slightly growing group, and 37.4 °C for the growing group (P < 0.01). The area under the ROC curve for the temperature values to predict growth was 0.929. Temperatures at or above 37.4 °C showed a specificity of 95%, a sensitivity of 75%, a positive predictive value 81%, and a negative predictive value of 95%.Conclusions: IRT is a time and cost effective tool, and is easy to learn. The surface tempera- ture of IH reflects its remaining growth potential and could be used in the outpatient setting for the evaluation and follow-up of IH. Full article

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Open AccessArticle

Maternal obesity and obstetric outcomes in a tertiary referral center

by Gitana Ramonienė, Laima Maleckienė, Rūta Jolanta Nadišauskienė, Eglė Bartusevičienė, Dalia Regina Railaitė, Regina Mačiulevičienė and Almantas Maleckas

Medicina 2017, 53(2), 109-113; https://doi.org/10.1016/j.medici.2017.03.003 - 19 Apr 2017

Cited by 23 | Viewed by 1432

Abstract

Background and aim: Obese women are at an increased risk of various adverse pregnancy outcomes. The aim of our study was to evaluate the impact of obesity on maternal and neonatal outcomes in a tertiary referral center and to compare obstetric outcomes [...] Read more.

Background and aim: Obese women are at an increased risk of various adverse pregnancy outcomes. The aim of our study was to evaluate the impact of obesity on maternal and neonatal outcomes in a tertiary referral center and to compare obstetric outcomes by the level of maternal obesity.Materials and methods: A cohort study included 3247 women with singleton gestations who gave birth at the Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences, in 2010. Pregnancy complications and neonatal outcomes were identified using the hospital Birth Registry database in normal weight (body mass index [BMI] 18.5–24.9 kg/m², n = 3107) and prepregnancy obese (BMI ≥30 kg/m², n = 140) women. Pregnancy outcomes were compared according to the level of obesity (BMI 30–34.9 kg/m², n = 94 and BMI ≥35 kg/m², n = 46). Results: Obese women were significantly more likely to have gestational hypertension (OR = 8.59; 95% CI, 5.23–14.14; P < 0.0001), preeclampsia (OR = 2.06; 95% CI, 1.14–3.73; P < 0.0001), gestational diabetes (OR = 5.56; 95% CI, 3.66–8.49; P < 0.0001), dystocia (OR = 2.14; 95% CI, 1.36–3.38; P < 0.0001), induced labor (OR = 2.64; 95% CI, 1.83–3.80; P < 0.0001), failed induction of labor (OR = 18.06; 95% CI, 8.85–36.84; P < 0.0001), cesarean delivery (OR = 1.76; 95% CI, 1.25–2.49; P = 0.001), large-for-gestational-age newborns (OR = 3.68; 95% CI, 2.51–5.39; P < 0.0001). Significantly increased risk of gestational diabetes, preeclampsia, dystocia and newborns with Apgar score ≤7 after 5 min was only observed in women with BMI ≥35 kg/m². Conclusions: Maternal obesity is significantly associated with an increased risk of gestational hypertension, preeclampsia, gestational diabetes, dystocia, labor induction, failed induction of labor, large-for-gestational-age newborns and cesarean delivery. Full article

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Open AccessArticle

Interaction of ethidium and tetraphenylphosphonium cations with Salmonella enterica cells

by Valeryia Mikalayeva, Sandra Sakalauskaitė and Rimantas Daugelavičius

Medicina 2017, 53(2), 122-130; https://doi.org/10.1016/j.medici.2017.04.001 - 17 Apr 2017

Cited by 3 | Viewed by 1090

Abstract

Background and objective: One of the main causes of bacterial resistance to antimicrobials is multidrug resistance induced by the increased efficiency of the efflux pumps. In this study we analyzed how the conditions of assay affect the efflux of indicator substrates ethidium (Et [...] Read more.

Background and objective: One of the main causes of bacterial resistance to antimicrobials is multidrug resistance induced by the increased efficiency of the efflux pumps. In this study we analyzed how the conditions of assay affect the efflux of indicator substrates ethidium (Et⁺) and tetraphenylphosphonium (TPP⁺) in Salmonella enterica ser. Typhimurium cells. Impact of the outer membrane permeability barrier, composition and temperature of the medium on accumulation of the indicator compounds also was analyzed.Materials and methods: The fluorescence of Et⁺ and Nile Red was measured using 96-well plates and a plate reader. In parallel to traditional studies of fluorescence we applied a constructed selective electrode to follow the accumulation of Et⁺ in S. enterica cells. Simultaneously with monitoring of Et⁺ concentration in the cell incubation medium, electrochemical measurements of TPP⁺ accumulation were performed. Furthermore, Et⁺ and TPP⁺ were used within the same sample as agents competing for the interaction with the efflux pumps. An inhibitor phenylalanyl-arginyl-β-naphtylamide (PAβN) was applied to evaluate the input of RND-family pumps in the total efflux of these indicator compounds.Results: S. enterica cells with the intact outer membrane (OM) bound very low amounts of Et⁺ or TPP⁺. Cells with the permeabilized OM accumulate considerably higher amounts of the indicator compounds at pH 8.0, but only Et⁺ was considerably accumulated at pH 6.5. At conditions of electrochemical monitoring accumulation of Et⁺ by the permeabilized cells at 37 °C was considerably faster than at 23 °C, but at the higher temperature most of the cellaccumulated Et⁺ was extruded back to the medium. The fluorescence of Et⁺ in suspension of cells incubated in 400 mmol/L Tris buffer was about twice higher compared to 100 mmol/L one. The inhibitory action of TPP⁺ on Et⁺ efflux was evident only in 400 mmol/L Tris although PAβN effectively increased Et⁺ fluorescence at both buffer concentrations.Conclusions: Results of our experiments indicate that ionic strength of the incubation medium influence the selectivity, the medium temperature and the assay conditions impact the kinetics of efflux. The lower accumulated amount and the weaker fluorescence of Et⁺ registered in slightly acidic medium indicate that ΔΨ plays a role in the accumulation of this indicator cation. The bound amount of Et⁺ to the de-energized or permeabilized cells considerably varies depending on the conditions and methods of de-energization or permeabilization of cells. Tris/EDTA permeabilization of the cells does not inhibit the efflux. Full article

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Open AccessReview

Plasticity of vagal afferent signaling in the gut

by Gintautas Grabauskas and Chung Owyang

Medicina 2017, 53(2), 73-84; https://doi.org/10.1016/j.medici.2017.03.002 - 10 Apr 2017

Cited by 21 | Viewed by 1051

Abstract

Vagal sensory neurons mediate the vago-vagal reflex which, in turn, regulates a wide array of gastrointestinal functions including esophageal motility, gastric accommodation and pancreatic enzyme secretion. These neurons also transmit sensory information from the gut to the central nervous system, which then mediates [...] Read more.

Vagal sensory neurons mediate the vago-vagal reflex which, in turn, regulates a wide array of gastrointestinal functions including esophageal motility, gastric accommodation and pancreatic enzyme secretion. These neurons also transmit sensory information from the gut to the central nervous system, which then mediates the sensations of nausea, fullness and satiety. Recent research indicates that vagal afferent neurons process non-uniform properties and a significant degree of plasticity. These properties are important to ensure that vagally regulated gastrointestinal functions respond rapidly and appropriately to various intrinsic and extrinsic factors. Similar plastic changes in the vagus also occur in pathophysiological conditions, such as obesity and diabetes, resulting in abnormal gastrointestinal functions. A clear understanding of the mechanisms which mediate these events may provide novel therapeutic targets for the treatment of gastrointestinal disorders due to vagovagal pathway malfunctions. Full article

627 KiB

Open AccessArticle

Hepcidin serum levels and resistance to recombinant human erythropoietin therapy in hemodialysis patients

by Kristina Petrulienė, Edita Žiginskienė, Vytautas Kuzminskis, Irena Nedzelskienė and Inga Arūnė Bumblytė

Medicina 2017, 53(2), 90-100; https://doi.org/10.1016/j.medici.2017.03.001 - 31 Mar 2017

Cited by 16 | Viewed by 1299

Abstract

Objective: The aim of this study was to analyze the factors that are associated with the response to erythropoiesis-stimulating agents (ESAs) and its association with hospitalization and mortality rates; to evaluate the serum hepcidin level and its associations with iron profile, inflammatory markers, [...] Read more.

Objective: The aim of this study was to analyze the factors that are associated with the response to erythropoiesis-stimulating agents (ESAs) and its association with hospitalization and mortality rates; to evaluate the serum hepcidin level and its associations with iron profile, inflammatory markers, ESA responsiveness, and mortality; and to determine independent factors affecting ERI and hepcidin.Materials and methods: To evaluate a dose-response effect of ESAs we used the erythropoietin resistance index (ERI). Patients were stratified in two groups: nonresponders and responders (ERI > 15, n = 20, and ERI ≤15 U/kg/week/g per 100 mL, n = 153, respectively). Hematological data, hepcidin levels, iron parameters, inflammatory markers, hospitalization and mortality rates were compared between the groups. Multiple regression analysis was used to determine independent factors affecting ERI and hepcidin.Results: C-reactive protein (CRP) (β = 0.078, P = 0.007), albumin (β = 0.436, P = 0.004), body mass index (β = 0.374, P < 0.001), and hospitalization rate per year (β = 3.017, P < 0.001) were found to be significant determinants of ERI in maintenance hemodialysis (MHD) patients. Inadequate dialysis was associated with higher ERI. Patients with concomitant oncological diseases had higher ERI (31.2 ± 12.4 vs 9.7 ± 8.1 U/kg/week/g per 100 mL, P = 0.002). The hepcidin level was 158.51 ± 162.57 and 120.65 ± 67.28 ng/mL in nonresponders and responders, respectively (P = 0.33). Hepcidin correlated directly with ERI, dose of ESAs, ferritin and inversely with Hb, transferrin saturation, and albumin. ERI (β = 4.869, P = 0.002) and ferritin (β = 0.242, P = 0.003) were found to be significant determinants of hepcidin in MHD patients. The hospitalization rate per year was 2.35 ± 1.8 and 1.04 ± 1.04 in nonresponders and responders, respectively (P = 0.011). The mean length of one hospitalization was 25.12 ± 21.26 and 10.82 ± 17.25 days, respectively (P = 0.012). Death occurred in 30% of the patients from the responders' group and in 50% from the nonresponders' group (P = 0.289). The mean hepcidin concentration of patients who died was 141.9 ± 129.62 ng/mL and who survived, 132.98 ± 109.27 ng/mL (P = 0.797).Conclusions: CRP, albumin, BMI, and hospitalization rate per year were found to be significant determinants of ERI in MHD patients. Inadequate dialysis was associated with higher epoetin requirements. There were no difference in patient mortality by ERI, but a significant difference in hospitalization rates and mean length of one hospitalization was revealed. A significant positive relation between hepcidin and ERI was revealed. ERI and ferritin were found to be significant determinants of hepcidin in MHD patients. Hepcidin was not related to mortality. Full article

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Open AccessCase Report

Pathologic fracture of the thoracic spine in a male master ultra-marathoner due to the combination of a vertebral hemangioma and osteopenia

by Beat Knechtle, Pantelis T. Nikolaidis, Bruno Lutz, Thomas Rosemann and Christian B. Baerlocher

Medicina 2017, 53(2), 131-137; https://doi.org/10.1016/j.medici.2017.02.003 - 27 Mar 2017

Cited by 1 | Viewed by 3210

Abstract

Vertebral hemangiomas are the most common benign vertebral neoplasms and are generally asymptomatic. In the present study, we report the case of a 52-year-old male master ultra-marathoner suffering from a pathologic fracture of the thoracic spine due to a vertebral hemangioma. A further [...] Read more.

Vertebral hemangiomas are the most common benign vertebral neoplasms and are generally asymptomatic. In the present study, we report the case of a 52-year-old male master ultra-marathoner suffering from a pathologic fracture of the thoracic spine due to a vertebral hemangioma. A further examination in the athlete revealed an accompanying osteopenia, which was most likely due to a deficiency in both vitamin D and testosterone. The treatment of the fracture consisted of percutaneous vertebroplasty. Shortly after the operation the athlete was able to continue running. The most likely reason for the pathologic fracture of the vertebral body was the combination of the vertebral hemangioma and osteopenia. The further treatment consisted of supplementation of both vitamin D and testosterone. Athletes and physicians should be aware that male master ultra-marathoners older than 50 years might suffer from osteopenia, where a deficiency in vitamin D and testosterone could be contributing factors for osteopenia development in general. Full article

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930 KiB

Open AccessArticle

The comparison of knee osteoarthritis treatment with single-dose bone marrow-derived mononuclear cells vs. hyaluronic acid injections

by Valdis Goncars, Eriks Jakobsons, Kristaps Blums, Ieva Briede, Liene Patetko, Kristaps Erglis, Martins Erglis, Konstantins Kalnberzs, Indrikis Muiznieks and Andrejs Erglis

Medicina 2017, 53(2), 101-108; https://doi.org/10.1016/j.medici.2017.02.002 - 22 Mar 2017

Cited by 20 | Viewed by 1437

Abstract

Objective: The aim of this study was to compare treatment methods of the knee joint degenerative osteoarthritis, using autologous bone marrow-derived mononuclear cells and hyaluronic acid injections and observe prevalence of adverse effects in both groups. Materials and methods: A prospective randomized controlled [...] Read more.

Objective: The aim of this study was to compare treatment methods of the knee joint degenerative osteoarthritis, using autologous bone marrow-derived mononuclear cells and hyaluronic acid injections and observe prevalence of adverse effects in both groups. Materials and methods: A prospective randomized controlled clinical trial was carried out. The analysis of pain and changes in osteoarthritis symptoms after a single intra-articular bone marrow-derived mononuclear cell injection into the knee joint in the Kellgren– Lawrence stage II–III osteoarthritis during the 12-month period were performed. The results were compared with the control group treated routinely by hyaluronic acid injections therapy. A therapy group of patients (n = 28) received single bone marrow-derived mononuclear cell intra-articular injections. A control group of patients (n = 28) was treated with a total of three sodium hyaluronate intra-articular injections each one performed a week apart. The clinical results were obtained using the Knee Osteoarthritis Outcome Score (KOOS) and the Knee Society Score (KSS) before and 3, 6, and 12 months after injection.Results: A statistically significant improvement was observed in the mononuclear cell group over the starting point in all scores. At the endpoint at month 12, the KOOS score improved significantly (P < 0.05) on the pain subscale (+25.44), activity and daily living subscale (+21.36), quality of life subscale (+28.83), and total KOOS (+18.25). The KSS score also demonstrated a significant improvement on the symptoms subscale (+25.42) and the function subscale (+38.32) (P < 0.001). The KOOS symptoms and sports subscales improved without statistical significance. The difference between the control group treated with hyaluronic acid versus the bone marrow-derived mononuclear cells group at time points 6 and 12 months demonstrated a statistically significant (P < 0.05) superiority in the KOOS pain subscale over the hyaluronic acid group. In both groups serious adverse effects were not observed.Conclusions: The intra-articular injection of bone marrow-derived mononuclear cells is a safe manipulation with no side effects during the 12-month period. This treatment provides statistically significant clinical improvement between the starting point and 1, 3, 6, and 12 months after. When compared to hyaluronic acid treatment, better pain relief in the longterm period of mononuclear cell group was observed. Full article

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Medicina, Volume 53, Issue 2 (April 2017) – 8 articles , Pages 73-137

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